The Official Website of the State of Arkansas

Provider Enrollment

Provider Enrollment

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  1. Important Updates from Provider Enrollment
  2. Top 4 Reasons Provider Applications are Denied
  3. Need Help?
  4. Enrollment Resources
  5. Frequently Asked Questions
  6. Enrollment-Related Forms from Section V


Important Updates from Provider Enrollment

Current Provider Enrollment Forms

Providers must use the current versions of all required enrollment forms, as forms are updated periodically to reflect policy changes, new provider types, and newly required information. Using outdated forms may delay processing or result in returned submissions.

Where to Find Current Forms

Health Care Provider Portal Requirement 

Use the Health Care Provider Portal whenever possible. Information entered directly by providers or authorized staff allows for faster and more accurate processing.

  • When completing an application in the Portal, upload only the required documents and enter all requested information directly into the Portal when prompted.
  • Only upload required documentation. See the Required Document Finder to learn exactly what is needed with your application.
  • Forms that are outdated or can be entered through Portal self-service will be returned.

Submitting Fillable PDF Forms (When Portal Submission Is Not Available)

  1. Download and save the required form before opening it in Acrobat Reader.
  2. Complete all required fields, sign, and save the finalized document.
  3. Upload the document following the instructions in the “How to Upload Documents” job aid.

Using current forms and the Portal whenever possible ensures the most efficient enrollment processing and reduces the risk of returned submissions.

Electronic Submission Requirement for Initial Applications

Initial provider enrollment applications (excluding Long Term Care Facilities) must be submitted electronically through the Provider Portal. Electronic submission offers several advantages including:

  • Faster processing time — from weeks to days
  • Fewer issues with attachments and legibility
  • Real-time status updates
  • Reduced application returns for clarification, additional information, and associated mailing delays
  • Lower risk of missing revalidation deadlines resulting in temporary inability to submit claims
  • Higher approval rate for applications submitted through the Health Care Provider Portal

If a provider cannot complete the process electronically, the state will review exceptions on a case-by-case basis after the provider has exhausted all options to enroll using the portal.

Skilled Nursing Facilities are exempt from this requirement and should continue to submit on paper. General information from the Office of Long Term Care (OLTC) along with contact information for assistance with enrollment questions can be found on the OLTC webpage.

Practitioner Identification Number (PIN) requests must also be submitted electronically through the Provider Portal. DO NOT upload DMS-7708, Practitioner Identification Number Request Form, when submitting electronically.

Revalidation Requirements

Providers must revalidate every five years. The Health Care Health Care Provider Portal sends automatic notification letters before your expiration date. To avoid disruption:

  • Submit revalidation at least 60 days prior to the revalidation due date
  • Ensure all required documentation is submitted before the expiration date

Start your revalidation

Top 4 Reasons Provider Applications are Denied

  1. Name Mismatch
    The name on every document must match exactly – all attachments, licenses, certifications, W-9, and any other document submitted.

    For example, if a provider applies as “Benjamin J. Smith” and provides a license that reads “James Smith,” the application cannot be accepted because of mismatching names.

  2. Incorrect W-9
    • Individual providers: the W-9 must be completed with the individual’s name and Social Security Number.
    • Groups: the W-9 must be completed with the group’s name and Tax ID.
  3. Missing Attachments
    Applications cannot be submitted without all required attachments for the enrolling provider type. Use the Required Documents Finder (Excel, new window) to see what’s required for your provider type.
  4. Incorrect Signature
    • Individuals must sign their individual provider applications
    • Groups must have an authorized signer, such as a managing employee listed on the DMS-675 Ownership Disclosure form.
      NOTE: the Ownership Disclosure Form is captured by the online application and DMS-675 is included in the paper Application Packet for approved paper submissions.

Need Help?

Call Arkansas Medicaid Provider Enrollment:
(501) 376-2211 or toll free (800) 457-4454

Explore FAQs, training resources, and job aids for more guidance.

Enrollment Resources

The following resources may help you navigate the enrollment process.

Frequently Asked Questions

Provider enrollment is a vital step for healthcare professionals and organizations seeking to participate in the Arkansas Medicaid program. As the Arkansas Department of Human Services (DHS) continues to improve its enrollment process through the Health Care Provider Portal, providers now have access to a faster, more efficient, and more transparent way of enrolling, revalidating, and maintaining Medicaid participation.

The electronic enrollment submission process has significantly reduced processing times, minimized application errors and returns, improved communication between providers and enrollment specialists, and increased the number of successful application submissions. Understanding the enrollment process, documentation requirements, and common application drawbacks can help providers avoid delays and maintain uninterrupted participation in the Medicaid program.

Because we understand that enrolling as an Arkansas Medicaid provider can be confusing, the following Frequently Asked Questions (FAQs) address common concerns and offer guidance for navigating the enrollment process:

How can I become an Arkansas Medicaid provider?

To enroll as an Arkansas Medicaid provider, go to the online enrollment application. When applying online, it’s easier to avoid making errors that would result in your application being denied and returned to you for correction. If you fail to enter needed information, you will be prompted to provide it.

If you have questions about how to enroll, call Arkansas Medicaid Provider Enrollment at (501) 376-2211 or toll free at (800) 457-4454. View or print Provider Enrollment contact information.

If you are required to have a National Provider Identifier (NPI), you must report it to Arkansas Medicaid once enrolled as an Arkansas Medicaid provider. For more information about the NPI, view NPI frequently asked questions.

Who must pay an application fee?

Certain provider types are subject to an application fee set by the Centers for Medicare & Medicaid Services (CMS). The fee may be adjusted from year to year and is payable every five (5) years. This federally mandated fee is used to offset the cost of conducting screening activities associated with the Affordable Care Act (ACA).

View the list of providers required to pay the fee.

  • If the provider is enrolled in Medicare and has paid the application fee to Medicare, or if the provider is enrolled in another state’s Medicaid Program and has paid the application fee to that state’s Medicaid Agency, the provider is not required to pay the application fee to Arkansas Medicaid.
  • Individual providers (such as physicians, dentists, therapists) and groups of individual providers (such as physician groups, dental groups, and therapy groups) are not required to pay the application fee.

How often must I revalidate?

All providers are required to revalidate every five (5) years.

Who must complete a fingerprint-based background check to become an Arkansas Medicaid provider?

In accordance with title 42 CFR 455.434, 42 CFR 455.50 (c), and the Arkansas Provider manual section 141.103, federal fingerprint-based background checks are required for all high-risk providers and their owners who have a 5% or greater direct or indirect ownership interest as a condition of enrollment in the Arkansas Medicaid program.

Applicants who are required to complete the fingerprint-based background check will be notified by a letter from Provider Enrollment that will instruct how to complete the process. View or print a sample fingerprint-based background check letter.

How can I apply for a temporary Arkansas Medicaid provider number?

Arkansas Medicaid does not issue temporary provider numbers. To obtain an Arkansas Medicaid provider ID number, you must complete an application for enrollment.

What are some tips for helping my provider application, re-enrollment, or revalidation progress more smoothly?

Our enrollment specialists have listed some tips to help your application or revalidation progress more smoothly.

  • Apply online. Use the assigned tracking number to check your application’s status. You can also renew and revalidate your enrollment online using Resume Enrollment.
  • You must submit credentials (license, certification) annually. Please submit credentials online using the Health Care Health Care Provider Portal.
  • When enrolling for Electronic Fund Transfer (EFT) Authorization for Automatic Deposit, you must attach a voided check or a signed letter from the bank. Deposit slips are not accepted to set up EFTs. Note: Security validation will be performed for EFT enrollment and banking information changes.
  • If you have been terminated with Arkansas Medicaid for credentials (DEA, license, certifications) that have been expired for six (6) months or longer, you must submit a re-enrollment application.
  • Applications for individual providers must be submitted in their name, with their Social Security number, and their original or approved electronic signature. Applications for a group or facility must include the tax ID (FEIN) number and an original or approved electronic signature. This signature must be by an owner or managing employee listed on the application.

How can I change my PCP caseload?

Providers can change their patient caseloads on the Health Care Provider Portal. If the PCP caseload is set over 2500 using the online form, an error will be reported and no change will be made. If you would like to set the PCP caseload over 2500, Provider Enrollment requires a written request stating why the higher caseload is needed. The request should be attached online.

How can I change my demographic information?

Demographic information can be viewed after you have logged onto the Health Care Provider Portal under Characteristics. You must call enrollment to update this information, however. This is a security feature for your protection.

Why can’t I access the Health Care Provider Portal?

Currently active providers and providers who have been inactive for less than six (6) months have access to the Health Care Provider Portal. Inactive (six (6) months or longer) or suspended providers must contact the Provider Enrollment Unit before they will be able to log on the portal.

Both providers and trading partners are required to register on the Health Care Provider Portal. It is possible that you must register as both a provider AND a Trading Partner.

HIPAA requirements mandate the following security measures for the Health Care Provider Portal:

  • Users will be automatically directed to change their password if it matches their Tax ID/SSN or Medicaid/BreastCare provider ID.
  • Passwords must meet all of the password requirements for the Health Care Provider Portal.
  • Users must select a security question and provide an answer to that question to be used later to unlock the account or recover a password.
  • Security question answers must:
    • Be at least 4 characters long
    • NOT contain the user ID
    • NOT contain the security question
  • Users will be redirected to the log-on page if there is no activity on a secure page for more than 20 minutes.
  • Users will be locked out of an account automatically after six failed log in attempts within an hour.

What are the requirements for passwords on the Health Care Provider Portal?

Passwords for the Health Care Provider Portal must adhere to specific requirements. All passwords are case sensitive and must:

  • Be eight (8) characters in length
  • Contain at least one (1) alpha character
  • Contain at least one (1) numeric character
  • Contain at least one (1) uppercase character
  • Contain at least one (1) lowercase character
  • Contain at least one (1) special character
  • NOT contain the same character more than twice
  • NOT contain the user ID
  • NOT be any of the previous six (6) passwords

Where can I get more information about Practitioner Identification Numbers (PIN)?

Frequently asked questions about Practitioner Identification Numbers (PIN) have been answered to provide more information. View PIN frequently asked questions.

When completing my enrollment application electronically, am I required to mail original signatures?

No. Providers should complete and sign their applications electronically on the Health Care Provider Portal – paper is only accepted when pre-approved for submission.

How do Caregivers enroll?

Caregivers can enroll online through the Health Care Provider Portal.

For more information on completing an electronic request in the Billing Portal, see the “How to Submit a PT 95 NT Application” tool. This tool can be used to help navigate the 95 NT PIN request.

Once the caregivers are enrolled, they will be given a provider number which may also be called a PIN (personal identification number).

What electronic and digital signatures will Arkansas Medicaid accept?

Arkansas Medicaid will accept electronic signatures in compliance with Arkansas Code § 25-31-103 et seq.

Enrollment-Related Forms from Section V

Please remember that requests received by Provider Enrollment for tasks and updates that can be completed using self-service options on the Health Care Provider Portal will be returned to the provider.

Always submit current versions of required enrollment forms found here or in Section V. Using outdated forms may delay processing or result in returned submissions.